University of Oulu

Robel K. Gebre, Jukka Hirvasniemi, Iikka Lantto, Simo Saarakkala, Juhana Leppilahti, Timo Jämsä, Structural risk factors for low-energy acetabular fractures, Bone, Volume 127, 2019, Pages 334-342, ISSN 8756-3282,

Structural risk factors for low-energy acetabular fractures

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Author: Gebre, Robel K.1; Hirvasniemi, Jukka2; Lantto, Iikka3,4;
Organizations: 1Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
2Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
3Division of Orthopaedic and Trauma Surgery, Oulu University Hospital, Oulu, Finland
4Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
5Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 3.3 MB)
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Language: English
Published: Elsevier, 2019
Publish Date: 2020-07-05


In this study, we aimed to clarify proximal femur and acetabular structural risk factors associated with low-energy acetabular fractures in the elderly using three-dimensional (3D) computed tomography (CT). Pelvic bones and femurs were segmented and modeled in 3D from abdominopelvic CT images of 121 acetabular fracture patients (mean age 72 ± 12 years, range 50–98 years, 31 females and 90 males) and 121 age-gender matched controls with no fracture. A set of geometric parameters of the proximal femur and the acetabulum was measured. An independent-samples t-test or a Mann-Whitney U test was used for statistical analyses. The fractured side was used for proximal femur geometry, while the contralateral side was used for acetabular geometry. The neck shaft angle (NSA) was significantly smaller (mean 122.1° [95% CI 121.1°–123.2°] vs. 124.6° [123.6°–125.6°], p = 0.001) and the femoral neck axis length (FNALb) was significantly longer (78.1 mm [77.0–79.2 mm] vs. 76.0 mm [74.8–77.2 mm], p = 0.026) in the fracture group than in the controls when genders were combined. The NSA was significantly smaller both for females (120.2° [117.8°–122.6°] vs. 124.7° [122.5°–127.0°], p = 0.007) and for males (122.7° [121.5°–123.8°] vs. 124.6° [123.4°–125.7°], p = 0.006) in the fracture group. However, only males showed a significantly longer FNALb (80.0 mm [78.9–81.1 mm] vs. 77.8 mm [76.6–79.0 mm], p = 0.025). No statistically significant associations of acetabular geometry with fractures were found. However, the mean values of the acetabular angle of Sharp (34°), the lateral center-edge angle (40°), the anterior center-edge angle (62°), and the posterior center-edge angle (105°) indicated possible over-coverage. In conclusion, our findings suggest that proximal femur geometry is associated with low-energy acetabular fractures. Especially elderly subjects with an NSA smaller than normal have an increased risk of acetabular fractures.

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Series: Bone
ISSN: 8756-3282
ISSN-E: 8756-3282
ISSN-L: 8756-3282
Volume: 127
Pages: 334 - 342
DOI: 10.1016/j.bone.2019.07.004
Type of Publication: A1 Journal article – refereed
Field of Science: 3111 Biomedicine
Funding: This study was financially supported by CINOP Global through the NICHE project NICHE/ETH/246 funded by EP-Nuffic (Netherlands). Dr. Esa Liukkonen is acknowledged for his contribution to the gathering of images from PACS of Oulu University Hospital.
Copyright information: © 2019. This manuscript version is made available under the CC-BY-NC-ND 4.0 license